| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
208 |
184 |
$7K |
| V2020 |
Frames, purchases |
150 |
121 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
42 |
$613.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
42 |
$390.67 |
| 92015 |
Determination of refractive state |
56 |
51 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
17 |
17 |
$0.00 |